Advocating for Yourself in Fertility Care (Episode 343)

Full Transcript: Episode 343

This is the Fertility Friday podcast, episode number 343.

Lisa: Welcome to the Fertility Friday podcast, your source for information about the Fertility Awareness Method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Charting Journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys. I know, I know, I’m a busy girl, but I managed to fit it all in. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health. And I’m so excited that you’re here with us today.

Today I’m sharing a brand new episode in my Fertility Awareness Reality series. I’m sharing my conversation with my client Anna, and we really get into some interesting and important aspects. I think one of the themes that really came out in today’s episode is the importance of advocating for yourself when you’re looking to get the care that you need, but it’s also an important reminder that it’s not always easy to do so. So without further ado, let’s jump into today’s episode with Anna.

Lisa: And I’m excited to be here today with Anna. Anna is a member of my Fertility Awareness Mastery program and we actually just finished yesterday, so this is great, great timing. Welcome to the show, Anna.

Anna: Thank you. I’m really happy to be here.

Lisa: Well, I’m so excited to have you and I would love to start by giving you an opportunity to share a little bit about your experience. So I feel like this is probably not the only podcast out there, but one of the few where the first question is like, so you know, how old were you and you had your first period, and how was that experience? So I’d love for you to take us through what that was like, how you managed your fertility, and basically what brought you to where you are now with wanting to focus on fertility and charting.

Anna: Oh perfect, yes. Well, I think my story is a little bit unique because I feel like, as was ever in the class, I’m significantly older than everyone that was in your class. I’m 47. So my first period was many years ago, I think I was 13. To be honest, I’m really surprised that it did not stay in my mind as a significant memory. I kind of, as I’ve been doing a lot of reading, kind of feel like, oh, I wish that would have been more meaningful to me, but somehow it wasn’t. But it was pretty uneventful. And I think that’s one thing that probably has characterized my menstrual cycle for most of my life. It was uneventful in terms of PMS was not something that was disruptive. I would get some cramping when I was in my high school years, I would get like styes, that was my main thing, but I really never had acne or breakouts or anything really too disruptive. I get a little moody, I still do a little bit, but it was never, my period was never something that was a significant marker for me. I had no body literacy knowledge. And my background might be a little bit unique to my experience, but maybe others can relate in that I grew up in a pretty conservative Christian school for which there was no sex education and also a pretty religious background in terms of how that impacted sexuality. So in a way, it was kind of a moot point. Unless you were married and trying to have children, it was not a topical conversation. And so with it not being disruptive, I pretty much went through life without really even thinking about it. And as I got older and evolved and set up my own life, I was going to get married when I was pretty young and I broke off that engagement. And then I just sort of pursued my life and became really passionate about the work that I did. And as I look back, it was really throwing all my energy into it. I’m kind of a, if you know the Enneagram, I’m a seven, so I’m an enthusiast. I throw myself all in and I’m interested in many things. I’m pretty social. And I just didn’t notice time passing by, I think, and didn’t, because of my religious background, and while my faith has shifted over time for sure, during those years I wasn’t sexually active, and so I really just didn’t even, I never took birth control, so probably one of the few people that you might talk to that at 47 has never taken birth control. So basically I had two different times I had partners with whom I was sexually active, where it was like, oh, maybe I could have conceived, but I wasn’t actively trying, I had protected sex. And so I got here to, I got married in July, so I’m really excited, I was really excited to wait to meet a partner for me that was right. And even though I have wanted to be a mother, and probably that’s probably a bigger story, of the kind of as I’ve gotten to this age, really grieving both the loss of not having raised a child, but also exploring mothering in different ways. So that’s kind of like preoccupied my time. And now that I am married, it’s like, whoa, is there even a possibility? So I began exploring, like, I don’t really know anything about this. And found that perimenopause and pregnancy are not two things that generally go in the same conversation with medical providers. And so I was wanting to understand, my husband, who actually has three children that are nearly all adults, a 17, 18, and 21 year old, decided that he did want to try to conceive with me. And so he had a reversal and was successful. And he has held on to, well, if you’re having a period, that means that you can get pregnant, and it seemed simple enough and positive, and I was like, oh well, okay, let’s try that. And then I learned so much about, that’s not necessarily the case. I came across your information to really learn about body literacy, and part of that was because one of the things my husband said that was really helpful was, like, well, let’s find out if you’re a good incubator. Well, that was a super triggering phrase for me, good incubator, but it was really helpful because learning that you need to address like your underlying health, your gut health, and like you need to understand what’s going on with your body and that your charting can tell you so much about what’s going on with your body, so that’s how I made my way into your work, was really trying to understand where are we starting from. And while my husband used the term good incubator, for which he’s apologized many times, he is a scientist and I have background in health field and science training as well. And so it totally makes sense that you would want to evaluate and do an assessment of where you’re starting from for any kind of goal that you want to do. And so charting has been that kind of doorway for me to be able to understand and develop body literacy that I didn’t have and to understand where I’m at and be able to look at this experience and journey. It’s a question mark, there’s a lot of uncertainties whether or not it’s possible, but seeing the markers can help me know where I’m going and it’s not just a surprise, and it feels much less emotional, and that’s super helpful. So that’s how I got here, was wanting to learn about body literacy and wanting to learn what the factors were that were barriers, and I have had some, so I think we’ll be talking about those, but they’ve been really helpful for me to really feel self-aware and feel really grounded in this experience, because it’s really easy to get into a downward spiral with emotions when there’s something that you want that you can’t necessarily control. You can do things to help promote it, but it’s really a question of sitting with uncertainty and being willing to fully immerse in the journey, doing everything you can to promote that, but knowing that ultimately it will be what will be.

Lisa: Well, I mean, thank you for taking us through this journey. This is one of the reasons why these episodes are always my favorite, because even though we have been in a class together, when you have the opportunity to share your experience and kind of what brought you to today, there’s always all these little nuggets and pieces that I get to learn beyond what we’ve already spoken about. And so there’s a number of pieces of your story that are important and a bit unique. And I think, of course, there are still women out there who haven’t used birth control, but they are, it is kind of like a unicorn. But for what it’s worth, I have worked with several women who haven’t, but certainly it is not the majority. It’s always like, oh wow, how did you manage to avoid birth control? Tell me everything. And I think also part of what you’re speaking to, even if it’s indirectly, is the very real challenge that so many women are fully going through their lives, and we just don’t have an opportunity to learn about our bodies in this way. And I certainly, there’s certainly a number of women who reach out to me who are in their 40s, and it’s kind of like this bittersweet, I’m so glad I found you, but where were you 20 years ago, because I would have loved to experience this. And I think that your experience just speaks to the fact that obviously we can’t go back and change the hands of time and kind of learn in the past, but you can always start wherever you are and apply this knowledge and learn. And there’s so much that you have, just we were talking about this yesterday, but just in the past few months there’s so many different changes that you’ve made. And I think it might be useful for the audience if you would want to share some of the challenges. So one of the topics in our final session was choosing a provider that can support you, and you shared a few very compelling experiences that you’ve had having to advocate for yourself. And it really speaks to why it’s not always, it’s basically never, but not always easy to do that.

Anna: Yes, for sure. So actually the part of the advocating, and kind of starting to breed up and notice, beginning to learn about body literacy, was because of some health issues. Back in 2014 I had, well before then, I started to notice some pressure on my organs and I wasn’t sure what it was about, and I went and I was diagnosed with having fibroids. So there is a wait-and-see sort of approach to care, and I was like, you know, I would like to see what that’s like. And so I did a lot of diet things, but certainly they were very far advanced, so diet wasn’t going to take care of them. And so I was looking at having them removed. And the first OBGYN that I spoke with regarding this told me, because of your age, this was in 2014, so I think when I first saw her I was 39 and I had the removal when I was 40. She said, because of your age, you should go ahead and have a hysterectomy. And she had called me at work, which, when do doctors do that? Not very often, at least in my experience. I spoke with her personally and really was, I feel like the way the conversation was conveyed was a lot of fearmongering about having cancer and that being the risk factor, I should just go ahead and have a hysterectomy. And I found this really alarming, because I mean, I still very much wanted to have children and I had communicated that, and still on the side where it’s not like being 47 and trying to conceive. So that experience was like, oh no, there’s a lot of reasons besides wanting to conceive to not have a hysterectomy if you don’t need to, because there’s a lot of health issues that can emerge later in life that can be problematic. And so I’m like, I am not wanting to look at starting to get on hormones and all of these kinds of issues, and later in menopause, post-menopause, what having that can have implications for. So that was the first time where I was like, oh no, I need to find another provider. And so I used the strategy of, like, who would want to preserve my fertility? And so it turns out reproductive endocrinologists would want to, because I could be their IVF patient, I was like the perfect candidate. So I found a reproductive endocrinologist who would work with me and who assured me that she would steer clear of a hysterectomy unless it was an emergency in surgery. And so then, very last minute before the surgery, I was going to have laparoscopic, some research came out, and that was a time when they did the shredding in your body and didn’t take the tumor out, and there was some research that came out that somebody had developed cancer because of the shredding, the remains of the fibroid stayed in their body. And so I had a myomectomy last minute, so then I had the C-section cut, and I had a tumor which was quite large, I had a six pound tumor and a two pound, so I had the size of a baby, which was a little crazy. And so that became really important actually in my journey, because I had already started exploring adopting as a single mom, and then I had this tumor that felt really symbolic, like, wow, my body has produced this thing the size of a baby, I want to have a baby and it’s not a baby. So that helped me really try to explore, like, how did I get to this point of not being partnered, or like the things that I most want in life, my energy didn’t go towards that, and like what does that mean? So it was really a good marker to say, like, what is my body telling me, and it just felt like it was creating something, but not the thing that I wanted to. So I did a lot of work exploring that, and I went on to explore mothering more and like ways to do that that were really meaningful, and I’ve been tutoring a girl once a week for now, it’s been eight years, and that’s been really a joy in my life. So I think when we pay attention to our body and try to find the emotional connection, I think it can open up a lot of really beautiful things. So that was my first experience of saying, like, what’s the connection here? And it still is, like, a powerful reminder every time I see my belly with the C-section cut and no baby, it’s like, how are you using your time in life? So that’s something that’s been kind of cool. But it was a way that I had to advocate for a doctor to say, no, you are not doing a hysterectomy. I’m not going to listen to just one person, and then find someone who aligned with my values, which was keeping all my parts, and that would be aligned with what they wanted to do and their area of specialty. So that was really great. And then time passed, and I realized that I didn’t want to raise a child on my own, I’m not a solo girl. And so I went back to really trying to put efforts into being open-minded in terms of dating and all those things. So anyway, the other part is that when I revisited OBGYN this time, I again had fibroids, and went back to that same surgeon to do the surgery. They wanted to schedule me on a particular date, and so they said I had to get on birth control to do that date, and I said, absolutely not, I’m not doing that. And then they didn’t. So I feel like that has been an issue. And then in talking to, for example, looking at my gut health, I went to a GI doc because I was having significant bloating and just bowel movements that weren’t as they should be and just a lot of discomfort. And right after getting married in July I moved, and so my life hugely changed, and it’s COVID, and I’m a healthcare provider, and there’s a ton of stuff we’ve had to do because of COVID, so life has been pretty stressful even though I’m happily married. And I just was having such bad GI symptoms, I wasn’t sleeping and, like, for months. And so when I went to the GI doc, he was like, yeah, you don’t have anything, it’s just, basically, it’s dysbiosis, you just have to learn to live with it. And I was like, no, because of your podcast, Lisa, I had learned about SIBO. And as I did more studies, I realized, oh, the SIBO could be, I had an incident of food poisoning traveling in the jungle once when I was in Colombia, after my myomectomy, so 2015, and that can be related, or that pressure of the fibroid on my organs can also create structural issues that can relate to developing SIBO, which is a small intestine bacterial overgrowth. And so the idea of understanding, as I have from listening so much of what you’ve taught, is needing to get that gut health in place, with my husband’s being a good incubator, I’ve put a lot of work into that. And so I was able to get, the doctor tested me and I got a SIBO diagnosis, and then I pursued the information that you’ve had online. So I think it’s about really educating yourself. The GI doc pushed back on getting the testing, their procedures recommended were not in line with my values, and so I had to find someone whose approach was in line with what I wanted to do. And it’s been really important to understand where a provider is coming from, so that in these moments when you feel really emotional, really angry, you can have a sense of clarity to navigate, I think, finding providers whose specialty already lines up, because if you find a provider who’s not educated in the area that you’re wanting to pursue, it’s not going to be a match, and it’s not the provider’s fault, it’s just your responsibility to find the people that are compatible with the approach that you want to have, no matter how difficult. And natural conception at 47 is virtually a non-existent thing, but I did find a fertility acupuncturist because I’ve listened to your podcast and I’ve learned about fertility acupuncture. I’ve gone to one and she actually has a whole group of women, she specializes in working with women in their 40s and late 30s, and she actually has women who are my age who have naturally conceived, and one that’s even 52 right now that she’s seeing. So that was really awesome, to find this little circle of support through the providers. Because this is actually, while I’m on a podcast right now, this is a journey my husband is wanting to keep private, which totally makes sense because it’s such an uncommon thing, and I’ve totally respected that, but it’s been important to find my circle of people. And so your group, the Fertility Awareness Mastery charting class, has been a source of support. Your work has been, and then learning about all these different providers and modalities that relate specifically to my situation, even though it’s maybe not labeled as such, has been really, really helpful.

Lisa: That is incredible, there’s so much to unpack there. And I think one of the things that came to mind when you were sharing, especially when you were thinking about the removal of the fibroids and how to find somebody that actually wants to help you preserve your fertility, I’m sure I’m not alone when I say that hearing that part of your story, it’s just like, really, they’re going to pressure Anna to have a hysterectomy, it’s sad. But I think it’s important to face the reality that many women experience these types of unfavorable circumstances in their interactions with regular physicians because of the way the medical system is set up. But I loved what you said, because essentially you do have to get creative. So this is kind of a reminder to everybody who’s listening that when you are looking for the care that you really need for a specific issue, often you do have to get creative. I’ve probably said it in every single class I’ve done, if you want a doctor to do a certain test, sometimes you have to think of the magical words in their language that will result in that test being done. And what you said was brilliant, who would want to help me preserve my fertility, who would be motivated to do that? And then you found yourself a doctor who’s in the realm of fertility, even if it’s IVF treatment, who would then be willing to conduct the surgery in a way that would be most beneficial for your fertility. And I think that given the challenges of accessing medicine that’s supportive, that’s a good way to think about it. Who is motivated to help me, who is specialized in this area to help me? And so I feel like your experience really sparks a lot of ideas for how to go about getting that care. And there was one other thing that I wanted to speak to, because your experience with developing a tumor that was, like you said, about the size of a baby, so that concept that potentially the uterus makes fibroids sometimes, because if you think about what the uterus does, it’s this incredible creative organ that’s literally designed to grow human beings. And so I just wanted to speak to that briefly, because that’s certainly a concept I’ve come across many different times. I feel like the first time I came across it may have been in Women’s Body, Women’s Wisdom by Dr. Christiane Northrup, because I think she talks about that, and I’m sure she’s one of many, but that concept of the energetic outlet. So for anyone who’s hearing that for the first time and isn’t familiar with that concept, the energetic aspects of this whole process, it’s not to say, obviously I’m not saying this is the only reason a person can develop fibroids, but I think we would be remiss not to sometimes think about that possibility, that your body is kind of creating something in lieu of what you really want.

Anna: Yeah, I think so. I mean, I haven’t done a ton of reading on it, but I think there’s a sense of common knowledge that when we have cancers and things that show up in our body, we want to look at what are the things that we’re holding that are toxic in our lives. It doesn’t mean, for sure, that because someone is diagnosed with cancer, that is a result of, I’m not equating that, it’s not a correlation, but it’s the kinds of things that we want to think about, like where are there connections in exploring them, and there may not be, but just potentially exploring where are there those body, those emotional connections, because when we experience trauma, we know the human body holds that trauma, and if we don’t resolve those things they can a lot of times show up as, express themselves in different ways. And so I think in my case it was relevant, and it allowed me a lot of different work, like for example looking at, I have had trauma in my family and experienced trauma myself, and so it helped lead me to The Body Keeps the Score, which is an amazing book teaching us about how our body does hold trauma in ways that we can learn to release. And I did a lot of work also with the mother wound, Bethany Webster does that work, and it really looks at feminine wisdom and connections with our mothers, and how we can hold some of that in our bodies throughout our lives as barriers. And so those were really great things for me, active work that I’ve done that I feel has also been parallel to some of the health work I’ve been doing, changing my diet, really looking at stressors in my life, and using meditation and different types of modalities to help create a life that’s more grounded and centered. I think of it as making room, I’m making room for a possibility in my life and looking at what are all the barriers I can remove, that are both structural in my body and then maybe more symbolic.

Lisa: Well, I was just going to say, one of the things that you’ve spoken about, that we’ve spoken about outside of our conversation now, is that obviously it’s well known that there are challenges to conception as we get older, and at every turn you’re basically met with, oh, that’s never going to happen, oh, that’s impossible, and it’s not even on their radar, as you said, with perimenopausal women. And so one of the things that we’ve done in our class and through our work together is focus on the menstrual cycle and really just work to identify anything that can be improved and worked on. And you’ve really just done a ton within the last several months to improve overall health, which of course then spills over into menstrual cycle health. So as we kind of switch gears into the session part of our call today, let me know what you would like to talk about, what you’d like to focus on, and how I can help today.

Anna: So I have had a lot of improvement in my menstrual cycle in terms of the quality of the blood. I started off with dark brown blood and clotting during my menstrual cycle, and it was something that had become so regular, I can’t really remember when I wasn’t clotting. Some of the work that you’ve done, some of the interviews you did and so on, really talking about blood flow to the uterus, and really trying to figure out, you know, I had fibroids removed at 40, and at that time the reproductive endocrinologist said that I didn’t need to worry about it, that because of my age they wouldn’t come back because my hormones were on the decline, and then here I am at 47 and I had, in August, two fibroids combined size of 5 centimeters, and by October one of them was 6 centimeters on its own. So my body is producing a lot of estrogen, which I think is kind of an anomaly, not what they were anticipating, so trying to figure out how do I reduce my estrogen dominance, what are things I can do to help improve blood flow and those kinds of things. Within two months my last cycle was cranberry red, no clotting for two cycles in a row, and significant improvement in cervical mucus, and now knowing what charting is, like, oh, that is a thing. And actually when I was so excited about this, I was asking, when I first went to the reproductive endocrinologist for this roundabout of getting the fibroids removed, I asked her about cervical mucus, because when I was first starting the program I was noticing how scant it was and I didn’t realize how important that was, so I mentioned it to her and she said that she was unimpressed by cervical mucus, so it was like going solo, and I had to think about, oh, she does IVF, so she’s doing everything kind of artificially, creating the environment because they bypass the mucus, the mucus isn’t relevant to their process, and if you understand that, then it’s not like she’s being rude, she’s literally saying I’m not impressed because it doesn’t help her, she’s not relying on it, but then I needed to find somebody else to be excited with when I was like, oh my gosh, I have clear egg white and there’s a lot of it, it’s amazing. So it was not something that this provider was going to be excited about, but my fertility acupuncturist is, so that’s really good, because I remember her telling me when she started working with me, because we did set a goal, we’re going to try to conceive in January, we wanted to have like three or four months to prep, I know people recommend a year or two but I don’t have that option, so she told me, you’re going to have a gorgeous period by January, and I thought that’s kind of weird language, and I didn’t really envision what she was talking about, and then when I had all that white this past cycle, I was like, oh my gosh, this is amazing, it is beautiful. So it’s really funny to see kind of those things that we get excited about as we learn about body literacy. I think the place I’m at now is, and we’ve spent a lot of time talking just in the last two days because I was in the hot seat yesterday and we had our one-on-one consultation, so I feel like you answered so many of my questions, but we had talked about the luteal phase being too short, and I think just kind of going over, my understanding is that the follicular phase, or pre-ovulatory phase, those days generally don’t change in your cycle, when your cycle is longer or shorter it’s generally the luteal phase that’s changing, is that right?

Lisa: Actually it’s the opposite. So maybe I can tell you about that, because my functional, I mean my fertility acupuncturist is saying we really need to lengthen the luteal phase, and I thought my understanding, I could be wrong, this is why it’s so helpful for you to clarify for me, is that the progesterone in that part is more about implantation and being able to carry pregnancy. So can you talk a little bit about that?

Anna: And I know that we talked about yesterday that my phases, I’ve had two short cycles, but I have, that’s the norm, and then of course I had surgery which was traumatic and can affect your cycle, and then the other cycle that I had short, from the four months that I’ve been tracking the days, it was, I just had sort of a little emotional meltdown, that’s when I got all my diagnoses and the SIBO and the whatever, and it just, I was overwhelmed, and at that point I wasn’t seeing a way forward, and so I had a pretty dark month before I could kind of get my footing again, and so that makes sense, I was not sleeping and in a lot of pain at night from GI stuff. So those cycles make sense, but also cycles are short, I mean, I know that in perimenopause, as you head towards menopause, your cycles can get shorter and be overlapping and not be ovulating, that’s what one of the nurses told me was happening, except that since I was charting I’d already seen and used an ovulation kit, so I was like, that’s true, but you’re probably not talking about me at this very moment, but I’m just going to let it go.

Lisa: All right, well let’s go through some of these things, I’ll kind of go step by step. So generally speaking, when you think of the typical cycle, if we start with like a typical average 29-day cycle, the first half, the pre-ovulatory or follicular phase, is the most variable, but it doesn’t mean the second half can’t vary at all. But when you have a typical, general, healthy cycling woman, it’s usually going to be the pre-ovulatory phase that is changing, and then the post-ovulatory phase typically stays fairly constant. So what that means is, a healthy cycle is somewhere between 24 to 35 days with an average of 29 days. The follicular phase then can certainly range, and the end of the follicular phase is ovulation, so if you have a 24 to 35 day range, ovulation could happen as early as day 10, it could happen as late as day 24 or something like that. And obviously outside of the normal range, cycling women sometimes will have 50-day cycles or 60-day cycles. And so if you have a 60-day cycle, you would ovulate, let’s say, day 48, with a 12-day luteal phase. So when you’re having a really long cycle or a short cycle, it is the pre-ovulatory phase that is changing. Now the luteal phase can vary, most commonly with stress and illness and different issues of that nature, so the absolute range of the luteal phase, I’ve seen luteal phases as short as seven days, which is really, really short, so that’s not normal, but it can range on the long end up to say 16 days, although that’s not as common, and if it’s 16 or 17 days and you’re not pregnant, you’re going to want to look into ovulatory issues. So with that said, a normal luteal phase is about 12 to 14 days, and depending on what’s happening in your life there can be some cycle fluctuation due to the luteal phase, but it’s not as common to have, say, a seven-day luteal phase and then a 14-day one, it doesn’t really work like that. If the luteal phase is too short, there’s usually a reason for that, and you might have a day or two discrepancy between cycles, but it doesn’t typically jump in huge days unless there’s a reason. So hopefully that’s helpful. So what that means for you and the two cycles we’re talking about is there could have been a combination, some of that fluctuation due to how early ovulation was happening in the cycle, but certainly you could have lost a couple of days of the luteal phase due to stress, due to the surgery, those types of things. And if the cycle is already like 24 or 27 days, then if you lose three days it feels like a really big shift, and that could actually be related to the luteal phase. So hopefully that helps explain, because when the cycles are on the shorter end, changes in the luteal phase can obviously change the total cycle length, and it would be more meaningful if it goes from like 27 to 24 days.

Anna: And you said if the luteal phase is short there’s a reason for that, is low progesterone the reason generally, or are there several typical factors?

Lisa: Well, if you think about the role of progesterone in the cycle, progesterone is essential for implantation, and it plays a crucial role in pregnancy, pregnancy cannot happen without sufficient progesterone to prepare the uterine lining for implantation. But in addition to preparing the uterine lining for pregnancy, progesterone is essential for maintaining the uterine lining. So I often think of progesterone kind of like it’s holding up the uterine lining. So certainly when you have a really short luteal phase, when you have spotting or bleeding before your period starts, or breakthrough bleeding in the second half of your cycle, that’s an indication that progesterone isn’t in sufficient quantities to continue maintaining that lining. But that’s kind of a symptom of what’s really going on, low progesterone is kind of like that symptom. Sometimes it’s related to stress, so that’s something that when you chart you can see pretty clearly, if you’re not getting enough sleep, if you’re not eating enough, if you’re overworking out, if something really stressful happens, sometimes you can see that response in real time in line with whatever’s going on, and other times it can be related to other health conditions. And there’s an interesting relationship between progesterone and cortisol, our stress hormone, because we make cortisol from progesterone. That kind of demonstrates why there’s such a direct link, particularly in the luteal phase, between stressors and progesterone, because it literally takes from that progesterone. And if you think about it in a different way, so often we think of these problems as, oh, there’s something wrong with my body, but if you think about your body as a highly intelligent entity, then it would make sense that if there’s a ton of stress, or you’re not getting enough to eat and your body perceives that as starving, your body’s going to say, okay, maybe this isn’t the right time, and so it shows up as these symptoms. But then what do we do about it, of course, is the question. Really there are certain things that can’t be helped, like if you have surgery and your body responds a certain way, we can’t be like, ah, we just have to kind of, I take that as an acknowledgement that you went through something and it did have an effect, and so it can be a reminder to rest, a reminder to recharge and to really take that time. And for many women who chart, seeing those changes in your cycle on your chart helps validate it, because I think as women especially we’re often like, it wasn’t that big of a deal, what’s wrong with me, we kind of do this to ourselves. And so seeing how our body is literally reacting on a physical level to what’s going on is the permission that we need to take it seriously and give ourselves a bit of space and leeway. So that’s kind of like the pep talk, but there are certain things we can’t really help, right, but outside of that, there’s a lot of things we can do to support progesterone production. We talked about the importance of sleep, getting enough to eat, sleeping in the dark, organizing your room, supporting supplements like magnesium, B6, vitamin C, different things that have been shown to support progesterone. One of the things you can do is have your practitioner test your progesterone levels mid-luteal, so not day 21 but seven days after ovulation, which can help, sometimes it’s helpful to have the actual lab number, sometimes it can be encouraging, oh, it’s not that bad. But one thing to keep in mind is that the length of a normal healthy luteal phase is about 12 days, so if the luteal phase is only 10 days long, you’re missing out on two days of progesterone, by definition you wouldn’t be getting as much progesterone if the luteal phase length itself isn’t as long. And so depending on the results and your timeframe, you can talk to your doctor about the possibility of progesterone. My recommendation is to chart, and of course talk with your doctor about it, but progesterone is intended to support what your body’s doing already, so you would want to take it after you’ve confirmed ovulation, not before, because if you take it before ovulation it can suppress ovulation, and I’ve seen that happen. And when you take progesterone it has a thermogenic effect on the body, so you start taking progesterone, the temperature goes up, and it looks like you’ve ovulated, but maybe you didn’t, so especially when you have a time constraint, you don’t want to lose out on cycles because of mistakes like that.

Anna: Right, right, that’s super helpful. I’m also working with a naturopath who will do the DHEA hormone test, and so I may have missed my window because my cycle is different than I anticipated, or it’s not normalized yet, so it’s kind of hard to anticipate when to get that test, because I think it’s like four days before you start your period, but it was variable because I tried it last month, but my cycle started before I thought it was going to, so I couldn’t do it. So it’s a little bit different when your cycle is off by a few days, but that totally makes sense. And I don’t feel like we’ve necessarily talked about progesterone supplementation, but the fertility acupuncturist was talking about that, so I did a little bit of reading and I guess it’s called progesterone pulsing, only doing it in that phase so that you’re not impacting ovulation, because they use synthetic progestins as birth control, right?

Lisa: Yeah, so that’s, any of my clients who’ve been through my programs are smiling right now because I kind of go on a rampage about this, because I’ve seen it happen so many times, I’ve seen so many clients told to start taking it on day 21, or day 19, or whatever they’re told, but if you’re not looking at the cycle and you haven’t ovulated by that day, you really can interfere with that process. So yes, if they call it pulsing, whatever they call it, just after ovulation, that’s perfect. And that’s another reason why charting is so important, and why being able to see the presence of the peak or non-peak and all the signs we’re looking for is really, really important.

Anna: So I feel so much more empowered that I have that knowledge, and even though I feel like I need to gain more confidence with my charting and have more time underneath my belt, I feel like it’s already been so helpful to understand. And I actually have an appointment this afternoon to see an OBGYN and start that conversation, so that’s something I feel much more confident about, and that’s thanks to charting and increased body literacy.

Lisa: Well, and just a few words of encouragement. You did have a couple of cycles during generally stressful periods of time that were a little bit different than what you anticipated, and this is something we’ve talked about in the class as well, because you don’t want to get married to what you anticipate, it’s hard, but you want to experience, like meditation, you just kind of have to experience and be open to what happens. If you see the mucus, air quotes, too early, you have to be open to the fact that you could be having an early ovulation, or if you see mucus and then it goes away and you see it again, you have to be open to the idea that maybe ovulation was delayed. So you kind of have to be open to the idea that it’s not necessarily going to go how you anticipated. And so it’s possible that this current cycle you’re in, given that a lot of those stressful situations have passed, notwithstanding the world.

Anna: Right, of course, because that’s a hot mess.

Lisa: But with that said, it’s very possible that this cycle, especially given the conversations that we had and the charting experience you’ve gained in the past two cycles, will make a lot more sense and feel a lot more understandable. And so I just want to encourage you in that way, because when you start charting, of course it’s all new and it can feel overwhelming, especially when you have those challenges. I always say it’s good to have those challenges when we’re together, because then it makes the more vanilla cycles, if you will, easier to manage. So I just want to give you some encouragement there in terms of understanding your cycles. And I mean, of course there’s tons more we could talk about, but I feel like that might be a good place to end today. So before we wrap up, did you have any other questions you wanted to talk about?

Anna: Only if you had any thoughts on the progesterone being vaginal, oral, or injections, if you’ve had any experience with that, specifically with women and perimenopause. And I know that’s not necessarily the crowd that is thinking about charting, and maybe unfortunately, which we should, because then we can know about our bodies instead of just what the doctors are telling us. So I do want to put a plug in for women in perimenopause, it’s not too late to be aware of your body.

Lisa: Right, and how much grounding and emotional comfort that is, to be aware of your own journey as opposed to what other people are telling you. So just wanted to put that plug out there. I think charting at any point, but particularly because that 10-year period before menopause, which is often referred to as perimenopause or premenopause, there’s a lot of changes, it’s like a second puberty in some ways, because your cycles change. We touched on very briefly that one of the common changes to the cycle is a shortening of the cycle, meaning earlier ovulation, so having 21-day cycles or 24-day cycles is much more common during that phase. And so it can be very helpful to chart to know when your period is coming and to understand your fertility during that time. And in terms of progesterone, since I’m not a physician, I’m not prescribing, I’ve primarily worked with clients who use the suppositories, but I would talk to your doctor or naturopath to see if there are any benefits to an injection or oral versus the vaginal suppository, because off the top of my head I’m not too sure. But certainly with the vaginal suppository option, for charting purposes it can be helpful to use it at nighttime, to minimize the effect, because obviously anything inside the vagina can come out and make it a little more difficult to check your mucus and things like that. So that kind of practical aspect of putting it in at nighttime minimizes the effect on the mucus during the day, that’s probably my best suggestion, but I’d look into it further because I’m not sure if there’s a benefit of one method of distribution over another.

Anna: Oh, that’s perfect, that’s super helpful. And just to clarify for me, if my cycle is following the typical pattern in terms of mucus after ovulation, I wouldn’t really be seeing anything, I’d be seeing dry days until I start my period, correct? So if I’m doing the vaginal suppository, it shouldn’t be that confusing, if I haven’t already had an issue with irregular mucus?

Lisa: Yeah, exactly. But I think it’s helpful to remember, because if you start to see, if it’s a cream, you start to see what looks like mucus post-ovulation, you might interpret that a certain way, but that reinforcement of what to expect is super helpful.

Anna: So I think I kind of nailed it on that one, for sure. Well, thank you so much, Anna, for coming to the show, this has been really eye-opening and I’m really excited to share this.

Lisa: I feel that these are the conversations, I mean, obviously that’s why we’re having them, but I feel that these are the conversations that are really important, that this is what it really looks like for women. And that’s why these continue to be my favorite episodes, because these are often conversations over the years that I’ve been privy to, given the nature of my work. And so I’m always thrilled to share this, so that everyone else can see what’s really going on, what this process really looks like. So a couple of last questions I like to end with, if someone is thinking about learning fertility awareness at whatever age, maybe they have a history of using hormonal birth control and they’re kind of nervous about switching over, what, if anything, would you want them to know?

Anna: I think that not going it alone is super important. I think having a community, and you offer a variety of ways to participate in community, that’s welcoming at different price points, making it more accessible. I think of books and podcasts, and many friends I have who are authors, and I think you can really find comfort in other people’s journeys, surrounding yourself with a community, whether it’s people you engage with verbally or other forms. There’s a writer I like, C.S. Lewis, who says we read to know that we’re not alone, and I think having that, and having professional, insightful help that’s balanced with both knowledge, you’re so evidence-based, which I so appreciate, but you really balance it with wisdom, and I think honoring those two sources of knowledge, the science and that internal wisdom that we carry, is just crucial for this journey, because this kind of journey is fraught with a lot of emotional, it’s just a very emotional experience, because it’s related to so many things, our body and expectations and fears, whether you’re trying to conceive or not, all of that can be surrounded with emotion. So I think really having a balanced approach in the community that you seek is really important, to make sure that it’s a nurturing, positive experience.

Lisa: Well, thank you for that. And for someone who’s thinking about the Fertility Awareness Mastery program and wondering what the experience is really like, what, if anything, would you want them to know?

Anna: I think that it’s super accessible. For instance, as we’re even doing this podcast, we had to switch rooms because I’m at work and I took time off for a telehealth appointment, which is what I’m calling this. But just the flexibility, I wasn’t able to attend live, but I was able to listen to it, and having access to all those resources, I think your handouts were amazing, I think it was really great to parallel with The Fifth Vital Sign and the workbook. I had actually purchased The Fifth Vital Sign, both audio and hard copy, before I was part of the class, I was familiar with the work beforehand and also all the podcasts. But I feel like it is really, really accessible. So I think that’s the thing to know, is that there’s a lot of flexibility. Having that community of folks, like I said, I have a really great group of girlfriends with whom I’m really close, but that’s not going to be part of what I look to for community in this journey, so finding other communities has been really helpful. And I think since it’s such a private nature, it may be that people want that space, so finding others with whom they can relate or have these discussions and get questions answered live is just invaluable.

Lisa: Amazing. Well, thank you so much, Anna, for being here with us, and I will see you soon.

Anna: All right, sounds great, thanks Lisa, take care, bye-bye.

Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/343.

Lisa: I hope that you enjoyed today’s episode with Anna. I really, really appreciated her taking us through her story and experience. And to be honest with you, there are so many common threads when you have conversations with women about their experiences in healthcare. I think that’s one thing that many of us have, we didn’t exactly want it, but we have this shared experience of having difficulty having health practitioners take us seriously, having difficulty really advocating and getting the care that we need. And it’s kind of like that reminder that when you really have to put your foot down, it’s a lot easier when you’re informed about the perspective of your provider, what they’re wanting to do and why, and what you want to do and what your values are and what’s important to you. So I feel like that’s a really important first step, but even if you know all of those things, it’s still not always easy to go against the grain and request either treatment or testing, or decline certain parts of treatment that you’re not comfortable with. But another important reminder is that it’s really you who is in charge of your healthcare, and you’re the one who gets to decide what you will and will not do. And so when a practitioner is telling you, oh, you have to do this, I appreciated Anna’s experience where she was told she had to take birth control prior to her surgery, and she informed the practitioner that she wasn’t going to do that, and somehow they managed to do the surgery without that requirement. So then it makes you wonder, why was it required, was it required at all? And so of course those are important conversations to have with your doctor. But I think the important reminder, an additional reminder, is that it’s okay to have those conversations, and it’s okay to ask for clarification. You told me that this is a requirement, could you explain why, and what happens if I don’t do it, is there any way for this to occur without that part of the procedure? You are the one who is in charge, and we should always ask questions and make sure that we fully understand all aspects of any procedures or anything that we’re doing when it comes to medical care, because that’s the only way that we can achieve true informed consent. So with that said, I wish you a wonderful week or weekend, whenever you are tuning into the show, and of course, as always, until next time, be well and happy charting.